Individual
DWAYNE HOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
50 MOODY ST, SACO, ME 04072-1536
(207) 294-4657
Mailing address
96 HARLOW ST, BOX 341, BANGOR, ME 04401-4925
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC7667
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431482699
—
ME
Enumeration date
08/03/2006
Last updated
07/08/2007
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